Now Even Family Assisted Suicide?

Her obituary  stated that Tessa was 55 years old and the divorced mother of two adult children when she died on May 14, 2002 in San Francisco, California after a nearly four year fight with breast cancer . She had been a real estate agent and later worked as controller in her son’s company.

Her son was Gavin Newsom, who just won the race for California governor November 6, 2018.

However and just the day before, a November 5, 2018 article in The New Yorker titled “Gavin Newsom, the Next Head of the California Resistance gave a different version of Tessa’s death:

“Newsom’s sister, Hilary, said that when their mother had breast cancer, in her fifties, he was difficult to reach. ‘Gavin had trouble explaining to me how hard for him it was to be with her when she was dying, and I had trouble explaining to him how much I needed him,’ she said. ‘Back then, he seemed like the kind of guy who would never change a diaper.’

In May, 2002, his mother decided to end her life through assisted suicide. Newsom recalled, “’She left me a message, because I was too busy: ‘Hope you’re well. Next Wednesday will be the last day for me. Hope you can make it.’ I saved the cassette with the message on it, that’s how sick I am.’ He crossed his arms and jammed his hands into his armpits. ‘I have P.T.S.D., and this is bringing it all back,’ he said. ‘The night before we gave her the drugs, I cooked her dinner, hard-boiled eggs, and she told me, ‘Get out of politics.’ She was worried about the stress on me.’” (Emphasis added)

Sadly, a previous 2016 San Francisco Chronicle article entitled How Gavin Newsom’s family tragedy led to ammo-control initiative” quoted Gavin Newsom on an earlier suicide tragedy in his mother’s life:

“My grandfather committed suicide, but not before putting his daughter — my mother — and her twin against the fireplace and saying he was going to blow their brains out,” Newsom said.”(Emphasis added)

THE CRAZY HISTORY OF CALIFORNIA’S PHYSICIAN ASSISTED SUICIDE LAW

I admit I was puzzled when California governor Jerry Brown signed a new law in September, 2018   titled  “AB-282 Aiding, advising, or encouraging suicide: exemption from prosecution”. This amended the 2016 physician-assisted suicide law that “Every person who deliberately aids or advises, or encourages another to commit suicide is guilty of a felony” to “A person whose actions are compliant with the provision of the End of Life Option Act (physician-assisted suicide) shall not be prosecuted under this section.” (Emphasis added)

For many years, California was especially targeted by assisted suicide groups like Compassion and Choices, the former Hemlock Society, for the legalization of physician-assisted suicide because of its size and influence. By 2015, there had been 8 failed attempts for legalization of physician-assisted suicide.

However, the Brittany Maynard tragedy started a media frenzy around the 30-year-old newlywed with an aggressive brain tumor when she announced that  she and her family left California for Oregon to commit assisted suicide where it was legal and picked November 1, 2014 for her assisted suicide. Brittany Maynard also became a spokesperson to raise funds for Compassion and Choice’s campaign to legalize assisted suicide throughout the US. Her family continued to vigorously fight for a physician-assisted suicide law in California after her assisted suicide in Oregon.

Significantly and because of the Brittany Maynard tragedy, most mainstream media outlets have now dropped the term “physician-assisted suicide” in favor of more palatable terms like “death with dignity” and “physician aid in dying.”

Surprisingly though, another attempt to pass  the “End of Life Options Act” in California failed in the 2015 legislature-until a sudden extra and controversial legislative session was called to pass it. This new law was signed into law by Gov. Brown and took effect in June 2016.

However in May 2018 and after at least 111 assisted suicide deaths, a Superior Court judge overturned the law, ruling it unconstitutional because of  how it was improperly passed in the special legislative session.

Physician-assisted suicide was again illegal until a month later when California’s 4th District Court of Appeals granted the state’s request to reinstate physician assisted suicide while it considers the case.

Then, as I mentioned before, Gov. Brown signed the law to prevent prosecution of anyone involved in an assisted suicide, including family members.

CONCLUSION

According to Findlaw:

“If you’re not a licensed physician, then assisting someone with suicide is most definitely a crime. But in states that have enacted “right to die” or “death with dignity” laws, eligible patients may request lethal drugs and administer them on their own.” (Emphasis added)

But the reality is that very few cases of a friend or family member assisting a suicide are prosecuted and even then, the penalty is light or nonexistent.  So-called “safeguards” are useless.

There is no chance that Governor Newsom will be prosecuted or even investigated for allegedly assisting his mother’s death in 2002 (long before California legalized physician-assisted suicide). But the new California law that forbids prosecuting anyone involved in a physician-assisted suicide who “aids or advises, or encourages suicide” further reinforces the dangerous myth that assisting  suicide is a victimless and even loving act.

Should a Mental Health Exam be required before Physician-assisted Suicide?

When I read the October 27, 2018 MedPage news article titled “Assessing Competency in Aid-in-Dying Patients (aka physician-assisted Suicide)-Should a Competency Exam by an Outside Doctor be Required?”, I was struck by one case cited by psychiatrist Richard Martinez, MD, professor of psychiatry and law at the University of Colorado Denver who opposes mandatory mental health exams as “an invasion of privacy ” …”(t)o mandate an interaction with a stranger”. Dr. Martinez also contends that “Depression should not be an exclusionary decision.” (Emphasis added)

Dr. Martinez cited the case of a young man who had a severe spinal cord injury after a fall and was on a ventilator to breathe. Doctors took him off sedation and asked if he wanted to live. He said no so the ventilator was removed and he died.

Although Dr. Martinez acknowledged that “people who work with people with spinal cord injuries have argued for a waiting period” and that this was a very difficult case in bioethics, he still maintained that, in the end, the issue is really about choice. (Emphasis added)

When I read this, I remembered when “Aaron” (not his real name) was admitted to our intensive care unit with a severe spinal cord injury after a car accident. This was in the early 1970s, long before the “right to die”/physician-assisted suicide movement became known to the public.

I was there when the doctors told Aaron that his legs were permanently paralyzed and he would never walk again. Naturally, this 18 year old young man was devastated. It didn’t take long before he told us he wanted to die. We were not surprised by this  normal reaction and the doctors wanted to stabilize him medically before ordering a psychiatric consult if he persisted in wanting to die.

One day while I was bathing Aaron, I asked him if many people complimented him on his legs. Aaron was puzzled but answered “No”. Then I asked him if his legs were the most important part of him. After a pause, he smiled a little and said probably not.

Then I talked with him about what he would still be able to do once he was medically stable and what he might be able to do in the future with rehabilitation and medical advances. Aaron looked a little less forlorn. I reassured him that we doctors, nurses and his wonderful family would be there every step of the way and I predicted how much better he could feel with time and more information.

But what really made a difference was when Aaron’s parents told me how much he enjoyed poker. So one quiet night, I started a midnight poker game in Aaron’s ICU room with the nurses taking turns between caring for the patients and playing. It was great to see Aaron finally laughing and making fun of how badly we played.

Even though we were caught by an unexpected visit from administrators and I had to promise never to do this again, it was worth it. When I last visited Aaron after he left our unit, he was laughing and talking to his friends. And making plans.

Supporters of physician-assisted suicide claim that one of their strongest safeguards is, as the Oregon physician-assisted suicide law states, that “If, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling.” (Emphasis added) But only the evaluation of a patient’s competence to make such a decision- not the diagnosable mental disorders that afflict more than 90 percent of people who die by suicide- is required .

However, now that supposed “safeguard” is being questioned by some psychiatrists in this new MedPage article reporting on a panel discussion during the 49th annual American Academy of Psychiatry and the Law (AAPL) meeting.

In the article, psychiatrists like Anna Glezer, MD, an associate professor of psychiatry and of ob/gyn at the University of California San Francisco (UCSF) who supports requiring a mental health exam stated:

“A psychiatrist can help identify potentially treatable psychiatric symptoms that may relieve elements of patient suffering, and detect family agreement versus family conflict that may require further intervention and counseling,”

and

‘”I’ve done a case where I didn’t say ‘This person meets the criteria or doesn’t,’ but [instead said] ‘These are my concerns,'” she said. In this case, the patient had lost her husband within the past year “and I thought grief might be compounding her decision-making capacity.” (Emphasis added)

Dr. Ariana Nesbit, a psychiatrist at the San Diego Central Jail says PAD (physician-assisted death aka physician-assisted suicide) is a complicated issue, stating that:

Our goal is often thought to be to prevent suicide, and we still conceptualize suicidal ideation as a symptom and pathological. As someone who just recently finished training in three very liberal states, I can tell you that at no point during my training was I ever taught how to figure out whether someone’s suicidal ideation, or their suicide attempt, was rational, so we don’t have any widely accepted method for determining this.” (Emphasis added)

Dr. Nesbit also cited a study titled “Prevalence of depression and anxiety in patients requesting physician’s aid in dying: cross sectional survey” that found 26% of patients requesting physician-assisted suicide did meet depressive disorder criteria but three of them were approved for physician-assisted suicide anyway. The authors concluded that “Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.” (Emphasis added)

During a question and answer session, Annette Hanson, MD, adjunct assistant professor of psychiatry at the University of Maryland in Baltimore, questioned whether PAD itself was a good idea. “We’re not just consulting psychiatrists — we’re members of a profession,” she said. “We’re shapers of healthcare policy that will affect everyone in the country … including people who are institutionalized, including people who don’t have physical illnesses.” (Emphasis added)

Dr. Hanson told how she was contacted by a colleague who asked her how to do such an mental health exam on a patient seeking assisted suicide in Switzerland. because of an “irreversible neurological condition”.  Dr. Hanson said, “It turned out the ‘irreversible neurologic condition’ was schizophrenia”. Dr. Hanson concluded that “So the publicity surrounding the right-to-die movement is hurting our psychiatric patients.” (Emphasis added) She also added that “the American Psychiatric Association also considers [PAD] to be unethical, and re-emphasized that in [amicus] briefs to the Supreme Court.”

Another MD talked about self-care for doctors after making mental health exams for physician-assisted suicide, saying that she deliberately tried “not to find out what happened to the patient” but still often found out what happened to the patients she evaluated when she would see an announcement about a memorial service

CONCLUSION

I am glad that I became a nurse decades before state legalized physician-assisted suicide. Back then, I saw what happened with patients like Aaron when we didn’t have the assisted suicide “option”: Patients received a chance for the best life possible and we received a chance to show how much we cared.